EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection

Lampertico, Pietro; Agarwal, Kosh; Berg, Thomas; Buti, Marı́a; Janssen, Harry L.A.; Papatheodoridis, George V.; Zoulim, Fabien; Tacke, Frank

doi:10.1016/j.jhep.2017.03.021

Cited by 4,184 publications

(3,542 citation statements)

References 230 publications

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“…However, its interactions with host factors and viral factors, such as markers of HBV transcription, have not yet been systematically studied. In this study, we investigate the association of HBV RNA serum levels with currently used HBV markers and patient characteristics in a large, multiethnic cohort including 441 HBeAg‐positive and 133 HBeAg‐negative individuals who were candidates for antiviral treatment according to current guidelines 10. We found that HBV RNA levels are independently associated with HBeAg status, ALT levels, BCP variants, and HBV genotype.…”

Section: Discussionmentioning

confidence: 96%

“…However, before the further development of serum HBV RNA as a response‐predicting marker, it is mandatory to evaluate which factors which may influence HBV RNA levels in individuals who are eligible for treatment. To study this, we measured serum HBV RNA level in a large, multiethnic population of well‐characterized individuals with chronic HBV infection, who are in need for treatment according to recent guidelines 10. We assessed the association with between HBV RNA level and host and viral factors, including levels of other biomarkers.…”

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confidence: 99%

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Host and viral factors associated with serum hepatitis B virus RNA levels among patients in need for treatment

et al. 2018

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Hepatitis B virus (HBV) RNA in serum is a novel biomarker for intrahepatic HBV replication and treatment response. For its proper use, it is essential to identify factors influencing serum HBV RNA level. Using a rapid amplification of complimentary DNA (cDNA) ends (RACE) PCR technique (lower limit of detection [LLD], 800 copies/mL [c/mL]), serum HBV RNA levels were measured in samples of 488 untreated individuals with chronic HBV infection who were eligible to treatment according to currently used recommendations. We explored the association of serum levels of HBV RNA with patient‐ and virus‐associated factors. HBV genotype distribution was 21/10/20/46/3% for A/B/C/D/other. Mean HBV RNA serum level was 5.9 (1.6) log10 c/mL (hepatitis B e antigen [HBeAg]‐positive chronic hepatitis B [CHB], 6.5 [1.2] log c/mL; HBeAg‐negative CHB, 4.1 [1.2] log c/mL; P < 0.001). By multivariable linear regression, factors associated with lower HBV RNA level were HBeAg negativity (β = –0.69; P < 0.001), HBV genotypes A (β = –0.13; P = 0.002), B (β = –0.07; P = 0.049), and C (β = –0.61; P < 0.001) in comparison to D, and presence of HBV basal core promoter mutation either alone (β = –0.14; P = 0.001) or in combination with precore mutation (β = –0.22; P < 0.001). Higher serum alanine aminotransferase (ALT) was associated with higher HBV RNA (β = 0.23; P < 0.001). HBV RNA correlated strongly with HBV DNA (HBeAg‐pos, r = 0.72; P < 0.001; HBeAg‐neg, r = 0.78; P < 0.001) and moderately with quantitative hepatitis B surface antigen (qHBsAg; HBeAg‐pos, r = 0.54; P < 0.001; HBeAg‐neg, r = 0.19; P = 0.04) and quantitative hepatitis B surface antigen (qHBeAg; r = 0.41; P < 0.001). Conclusion: In this multiethnic cohort of 488 untreated individuals with CHB, factors associated with serum HBV RNA level were HBeAg status, serum ALT, HBV genotype, and presence of basal core promotor mutations. For the future use of serum HBV RNA as a clinical marker, it seems mandatory to take these factors into consideration. (Hepatology 2018).

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confidence: 96%

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Host and viral factors associated with serum hepatitis B virus RNA levels among patients in need for treatment

et al. 2018

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“…Epidemiological studies report a prevalence of HBV/HCV coinfection in the 0.2% to 1.9% range, with higher rates in Eastern Asia 19. From a clinical standpoint, HBV/HCV coinfection is associated with faster disease progression, higher rates of liver cancer and reduced survival.…”

Section: Resultsmentioning

confidence: 99%

“…This is the direct consequence of negative reciprocal interaction between HBV and HCV replication. Several reports in the pegylated interferon era showed that achievement of an SVR could derange this balance leading to HBV reactivation once HCV was cleared 19, 20, 23.…”

Section: Resultsmentioning

confidence: 99%

“…Most importantly there is a need to assess the risk of reactivation in patients with isolated anti‐HBc serological profile (HBsAg negative, anti‐HBc positive), which represent more than 1 billion people worldwide 19. Current evidence does not show a major risk of reactivation in patients with positive HBc antibodies, with the few cases reported in the literature being biased by confounding factors, such as HIV coinfection, concomitant use of immunosuppressive therapy or concomitant extra‐hepatic malignancies 19, 27.…”

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confidence: 99%

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What do clinicians need to watch for with direct‐acting antiviral therapy?

Aghemo

Piroth

2018

J Intern AIDS Soc

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IntroductionThe introduction of drugs targeting the virus replication cycle has revolutionized treatment of chronic hepatitis C virus. These drugs, called direct‐acting antivirals, have brought about extremely high rates of virological cure and have increased the number of patients who can receive treatment due to the lack of absolute contraindications. A combination of different classes of direct‐acting antivirals is the current standard of care. Although treatment administration and monitoring has been simplified in recent years, it is still relatively complex and mostly in the hands of specialists. Several factors must be assessed before starting treatment to maximize efficacy and minimize side effects of treatment. In this review, we describe the factors that impact on the efficacy and safety of antiviral treatment for hepatitis C and provide clear recommendations for clinicians prescribing direct‐acting antivirals.MethodsWe reviewed literature to define best practice, based on factors associated with treatment efficacy and safety data to recommend treatment options, baseline and on‐treatment assessments. The review included searches in PubMed, and the abstracts presented at the International Liver Congress TM and The Liver Meeting TM between January 2013 and September 2017.ResultsClinical features that must be assessed before starting treatment include virological factors, such as hepatitis C virus genotype, HIV and hepatitis B coinfection and host factors, such as concomitant medications, liver disease stage and renal function.ConclusionsPatients who start antiviral treatment for chronic hepatitis C require a thorough clinical evaluation. There is a need for assessing factors that impact on the treatment schedule and duration or affect the pharmacokinetics of direct‐acting antivirals.

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Chronic Hepatitis B Infection

Tang

Covert

Wilson

et al. 2018

JAMA

557

473

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Antiviral treatment with either pegylated interferon or a nucleos(t)ide analogue (lamivudine, adefovir, entecavir, tenofovir disoproxil, or tenofovir alafenamide) should be offered to patients with chronic HBV infection and liver inflammation in an effort to reduce progression of liver disease. Nucleos(t)ide analogues should be considered as first-line therapy. Because cure rates are low, most patients will require therapy indefinitely.

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EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection

Cited by 4,184 publications

References 230 publications

Host and viral factors associated with serum hepatitis B virus RNA levels among patients in need for treatment

Host and viral factors associated with serum hepatitis B virus RNA levels among patients in need for treatment

What do clinicians need to watch for with direct‐acting antiviral therapy?

Chronic Hepatitis B Infection

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